Provider Demographics
NPI:1134106875
Name:MEDINA-SOTO, ROCHELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLY
Middle Name:
Last Name:MEDINA-SOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROOSEVELT AVE.
Mailing Address - Street 2:CLINICA LAS AMERICAS SUITE 101
Mailing Address - City:HATOREY
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2129
Mailing Address - Country:US
Mailing Address - Phone:787-765-7713
Mailing Address - Fax:787-250-7967
Practice Address - Street 1:400 ROOSEVELT AVE.
Practice Address - Street 2:CLINICA LAS AMERICAS, SUITE 101
Practice Address - City:HATOREY
Practice Address - State:PR
Practice Address - Zip Code:00918-2129
Practice Address - Country:US
Practice Address - Phone:787-765-7713
Practice Address - Fax:787-250-7967
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153952085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-2894Medicare ID - Type Unspecified
PRI26993Medicare UPIN